Cystoid Macular Edema Related to Uncomplicated Cataract Surgery and Topical Prostaglandin Analogs: A Systematic...

Cystoid macular edema (CME) presents with thickening of the macula with an accumulation of fluid due to breakage of the inner and outer blood-retinal barriers. It is referred to as pseudophakic CME (PCME) if it occurs after cataract surgery. PGF2a is a prostaglandin analog (PGA) used to lower intraocular pressure (IOP). In uncomplicated cataract surgery, the cumulative effect of topical PGA can make clinically significant PCME more prevalent. There are conflicting data regarding the association of PCME and the use of PGA in the perioperative period of uncomplicated cataract surgery, and its use remains controversial. We aim to determine the effect of PGA usage in the perioperative period in cases of uncomplicated cataract surgery on the development of PCME.

A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) in seven electronic databases was performed. The main outcome measure included the development of PCME diagnosed by clinical examination, OCT, or FA of adult patients (age > 16 years) undergoing routine cataract surgery using PGA in the perioperative period reported in randomized controlled trials.

The search returned 196 articles, and 155 unique citations were identified after removing duplicates. According to the inclusion and exclusion criteria, four studies were selected for our review. They did not find a measurable effect on PCME incidence by PGA in the perioperative period in patients undergoing cataract surgery.

The results show no causal relationship between PCME in patients using PGA undergoing uneventful cataract surgery, suggesting they do not have to be suspended in patients without known risk factors of PCME.